ABSTRACT Understanding of the frequency and distribution of occupational injuries is crucial for injury prevention and evaluation of injury prevention strategies. The past 25 years have seen profound changes in the economic and demographic factors that affect workplace safety. Nationally, employment has shifted away from manufacturing to services. Despite positive economic indicators, unemployment remains high in many communities, and there is increasing reliance on undocumented and immigrant workers. Like the US as a whole, North Carolina?s workforce has changed substantially over the past 25 years. The state has grown from 6.6 million to 9.9 million residents, employment has shifted dramatically from agriculture, textile, and furniture production to a more diversified economy and the population of Latino workers has increased nearly four hundred percent. The parent study of the current proposal provided a detailed description of the epidemiology of fatal occupational injuries in North Carolina over the period 1977-1991, utilizing the state?s medical examiner system as a tool for identification of fatal occupational injuries. The findings of that project, which continue to be used by injury epidemiologists, described trends in fatal injuries, disparities by race and ethnicity, and informed injury research and prevention strategies in a number of industries. We propose to build upon this parent study to provide contemporary data regarding fatal injuries in the southeast. The proposed research will address determinants of fatal occupational injuries in this large southeastern state over a 40-year time span. The proposed study will encompass a population of nearly 10 million residents followed from 1977-2016 in a state with a diverse economy and the fastest growing Latino population in the US. We will utilize the same case ascertainment methodology as the parent study, allowing us to generate a pooled database with an extended 4-decade follow-up of the population -- a unique contribution to occupational epidemiology. This proposed update includes analytical aims that will yield novel, highly informative findings addressing trends and disparities in fatal occupational injuries in North Carolina. A key stakeholder advisory panel and planned statewide summit will ensure that results are disseminated to key policy makers and workplace safety advocates. Results will inform future occupational injury research and prevention strategies in this region. In addition to the advisory panel and 1-day statewide summit, results will be disseminated via peer-reviewed journals and presentations at scientific meetings, a project website and twitter handle. The proposed study leverages a number of existing strengths by building upon longstanding collaborations between the state?s Department of Health and Human Services, the UNC Department of Epidemiology, and UNC?s Injury Prevention Research Center. The work will address NORA priorities by improving understanding of injuries across a wide range of industrial sectors and strengthening the basis for injury prevention efforts.